Understanding the Details of GPA & GMC Insurance Policy

Health Insurances 445 views

Talking about the health cover, most of the people tend to think there exist only individual & family health insurance policy and mediclaim insurance policy. But in reality, you have the luxury of several other options like maternity cover, personal accident cover and others. I don't know whether you have come across the term GMC and GPA insurance policies or not? But these policies can also provide the benefits that are available in other policies. So, without much ado, let's get on to the definition, features and benefits of GPA and GMC.

GPA

GPA, which stands for group personal accident, is an insurance policy meant for the protection of the selected group of people against the hazards of the accident, such as death, temporary or permanent disability, etc. The people who can get covered under the scheme are the company's employees, the family members of the employees or members of a particular group or community.

Coverage of GPA

Based on your requirements, you can get various group personal accident coverages ranging from basic to comprehensive coverage. Coverages are divided into

Basic CoverageAccidental death cover is provided with basic coverage. As per the coverage, the nominee of the dead subscriber will be provided the compensation stated in the policy.

Wider Coverage- The wider coverage, in addition to offering accidental death cover to the nominee, facilitates reimbursement in incidences of permanent and complete disablement or permanent or partial disablement of any member covered in the group.

Comprehensive CoverageThe comprehensive coverage offers protection to the insured and his/her family members. The coverage provides compensation during accidental death, permanent disablement, complete disablement, partial disablement and even temporary disablement. The compensation will be 100% of the sum insured to the dead member's nominee in accidental death coverage and 100% of the sum insured to the insured in permanent and complete disablement due to accident. In case of permanent and partial disablement due to an accident, compensation is provided to the insured as stated in the policy. Compensation for temporary disablement comes out to be 1% of the sum assured or Rs 5,000 whichever is less for a period of 104 weeks.

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Exclusions

No cover for natural death

No cover for accidents outside the geographical boundaries

No cover for accidents caused due to the intoxication

GMC

GMC, which stands for Group Medical Coverage, offers medical coverage to a group of people who can be the employees of a company, members of any social or community group, etc. GMC offers a slew of benefits like-

Hospitalization Expenses

GMC offers cover for expenses on behalf of any member covered for the treatment of ailments or accident, such as fees of doctor and nurse, room boarding rent, as well as cost of blood bottles, drugs, oxygen, anaesthesia required for the treatment of the patient.

Pre-hospitalization expenses

GMC also provides cover for pre-hospitalization expenses such as diagnosis, test, consultancy fees associated with the treatment prior to the admission of the patient in the hospital. Depending upon the terms and conditions of the chosen policy, you can get the cover for pre-hospitalization expenses for a period of 30-90 days.

Post-hospitalization Expenses

This group health plan also provides cover for the expenses incurred on consultation, diagnosis, tests subsequent to the treatment of the patient. The coverage is provided for 30-90 day only after the treatment based on the terms and conditions stated in the policy.

Day Care Procedures

GMC offers cover for expenses on treatments, which can be done within a day and the patient is not required to be admitted in the hospital beyond 24 hours.

Domiciliary Treatments

GMC provides cover for the expenses incurred on the treatment of any ill member of the covered group. Just in case if the patient is required to be treated at home, then this group health plan provides cover for doctor and nurse fees, along with costs of medical equipments and medicines needed for the treatment.

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Other Benefits

Other benefits like dental care, cover for employees' family member and maternity benefits are also provided.

Exclusions

  • Waiting period of pre-existing diseases
  • No cover for treatment outside India
  • No cover for AIDS, HIV
  • No cover for illness or accident caused due to the consumption of alcohol and drugs

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